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STATE OF CALIFORNIA. DEPARTMENT OF TRANSPORTATION <br />PROGRAM SUPPLMENT AND CERTIFICATION FORM <br />PSCF (REV. 01/2010) <br />Page 1_of 1_ <br />1 U: 5 I A It GUN I KULLtK'3 U"IGt DATE PREPARED: PROJECT NUMBER: <br />Claims Audits 3/26/2015 12, 5000025 <br />3301 "C" Street, Rm 404 REQUISITION NUMBER! CONTRACT NUMBER: <br />Sacramento, CA 95816 RQS # 121500000275 <br />FROM: <br />Department of Transportation <br />SUBJECT: <br />Encumbrance Document <br />VENDOR I LOCAL AGENCY: <br />City of Santa An <br />CONTRACTAMOUNT: <br />$22,132.00 <br />PROCUREMENT TYPE: <br />Local Assistance <br />ADA Notil For individuals with sensory disabilities, this document is available in alternate formats. For information, call (915) 654-8410 of TDD (916) -3880 or write <br />Records and Forms Management, 1120 N. Street, MS-89, Sacramento, CA 95814, <br />